A rare side effect of levosulpiride: Galactorrhea.

Sir,

Levosulpiride mainly acts by blocking D2 dopaminergic receptors located on the presynaptic membrane of the gastrointestinal tract and central nervous system dopaminergic pathways. The central D2 receptor antagonism is responsible for the therapeutic as well as the adverse effect of hyperprolactinemia.[1] Rabeprazole and levosulpiride combination pill is now being universally used for dyspeptic symptoms. However, long-term users are developing a major complication. Herein, we report a case of a patient who received levosulpiride for a duration of 5 months and developed galactorrhea.

A 26-year-old married female presented with a history of galactorrhea for last 3 months. She had no history of headache or visual disturbances. The patient had complains of dyspepsia for the last 6 months and was receiving rabeprazole (20 mg) plus levosulpiride (75 mg) combination pill (once a day) for the last 5 months. On examination, the patient was vitally stable. Her general physical and systemic examination had no obvious abnormality.

Her routine blood investigations were all normal, and serology for hepatitis B, hepatitis C, and HIV was negative. Her serum prolactin levels were raised (201 ng/mL; reference range 3.7–17.9 ng/mL). Magnetic resonance imaging of the brain was unremarkable. The patient was advised to stop the pill and was started on rabeprazole (20 mg) for her dyspeptic symptoms. Galactorrhea subsided within 2 weeks of withholding the inciting drug. Her follow-up serum prolactin levels after 2 months of withholding drug were within normal range (12.3 ng/mL).

Levosulpiride is commonly used for ailments such as nausea, vomiting, dyspepsia, depression, and psychosis. Levosulpiride blocks inhibitory D2 receptors on neurons and muscles, which is responsible for its prokinetic action on the gastrointestinal tract. Its interaction with type 4 serotonergic receptors (5HT4) enhances its therapeutic efficacy in functional dyspepsia and gastroparesis.[2] In a study by Lozano et al., 26.7% of patients receiving levosulpiride reported complications of galactorrhea.[1] There are few case reports that have reported serum prolactin level as high as 271 ng/mL in patients with levosulpiride-associated galactorrhea. Hence, before evaluating galactorrhea and hyperprolactinemia, a drug history must be carefully elicited.[34]

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